QUTHING, Lesotho — A new study from Stellenbosch University has found that Village Health Workers in Lesotho’s Quthing District are the single most important force keeping HIV patients on treatment but that they are doing so without adequate training, tools, or pay, while nearly half of all patients in the district receive no community support at all.
The study, titled “A Critical Assessment of the Role of Village Health Workers in HIV/AIDS Retention Activities in Quthing District of Lesotho,” was conducted by Rets’epile Motiki and supervised by Dr. Munyaradzi Saruchera, leading to the award of a Master of Philosophy in HIV/AIDS Management from Stellenbosch University in July 2025.
The research was carried out in Quthing District, located in the southernmost part of Lesotho — one of the most HIV-affected countries in the world, where an estimated 26.5 percent of adults in the district are living with the virus.
Quthing District is often referred to as Moyeni, meaning “Place of the Wind”. It is known for its dramatic Drakensberg Mountain scenery, significant historical sites, and rich cultural diversity.
Motiki interviewed 15 participants including Village Health Workers, ART nurses, a pharmacist, NGO representatives, and patients on HIV treatment.
Findings
The study found that Village Health Workers — known locally as VHWs — are the primary link between health facilities and the rural communities they serve.
Their daily work includes conducting home visits to patients who have stopped attending clinic, organising community support groups, counselling patients through fear and stigma, educating families about the importance of taking HIV medication without fail, and in many cases physically accompanying patients to hospital appointments when transport is the barrier.
Of the 15 participants interviewed, 73.3 percent were women, with most aged between 40 and 59 years and an average of 10.6 years of experience in community health — a workforce of seasoned practitioners receiving neither the recognition nor the resources their role demands.
The study’s most alarming finding is that a significant number of HIV patients in the district — nearly one in two — are receiving inadequate extension support. No home visits. No counselling. No follow-up when they stop coming to clinic.
“They are left to manage entirely on their own in communities where misinformation about HIV medication remains widespread and where disclosing one’s HIV status can carry serious social consequences,” Ms. Motiki tells ResearchFinds News.
While globally, only 74 percent of patients on HIV treatment remain in care after one year, the situation in Lesotho presents an urgent need for policy design and intervention.
Most crucially, the study identified several major obstacles preventing VHWs from doing their jobs effectively.
These include the vast geographical areas they are expected to cover on foot, in a mountainous district where roads are poor or non existent.
“VHWs also reported a severe lack of material resources. No transport allowances, no mobile phones for follow-up calls, and insufficient medical supplies,” reveals Ms. Motiki.
She further tells this website that inadequate training emerged as a critical gap and because of this, most VHWs are working with outdated knowledge and limited capacity to handle the psychological complexity of supporting patients through long-term HIV treatment.
Additionally, the study found out that cultural barriers, including deep-rooted stigma and community misconceptions about HIV medication, have further undermined their ability to keep patients engaged.
For example, a pharmacist interviewed during the study put the cost of inadequate support plainly:
“I know someone who lost a lot of money because he lacked technical support from an informed person. These are the gaps we need to address as government.”
Collaboration and Ongoing Support
Despite these constraints, the study found that VHWs who do operate with facility support are making a measurable difference.
“They work with hospital staff to track missed appointments, liaise with NGOs to secure food and transport support for patients, and partner with traditional leaders to break down community resistance to HIV care,” says Ms. Motiki.
An ART nurse interviewed for the study said: “Village Health Workers are essential in bridging the gap between the healthcare system and the community. Their practical support ensures that patients can remain in care and continue their treatment consistently.”
A patient on HIV treatment told the researcher: “The support from Village Health Workers feels different because they really understand our daily lives. Their community-based approach makes it easier to stay on treatment.”
Recommendations
Given these findings, the study recommends that VHWs should receive regular, updated training in HIV care, psychosocial counselling, and stigma reduction.
Secondly, the study recommends that the government in Lesotho must provide adequate resources including transport allowances, communication tools, and financial support to VHWs for community outreach.
Thirdly, the study recommends a structured collaboration between VHWs, health facilities, NGOs, and local authorities which must be be formalised rather than left to individual initiative.
Fourthly, the study recommends community-level campaigns engaging traditional and religious leaders in order to reduce stigma and normalise HIV treatment.
Fifth, and critically, VHWs themselves need emotional and psychological support including peer support groups and regular debriefing sessions to prevent burnout in a demanding and under-recognised role.
Why this study matters
The study is the first of its kind to examine VHW contributions to HIV retention specifically within Quthing District, and one of very few focused on the Lesotho context.
It matters because Lesotho implemented primary healthcare in 1979, with VHWs incorporated from the outset, but sustained, evidence-based attention to what they actually need to succeed has remained limited.
This rstudy therefore, fills this gap with field data and direct testimony from the workers and patients at the centre of the system, which the policy makers in government ought to scrutinize and inform their next course of action to reverse this crisis.
These findings are directly relevant to health policymakers in Lesotho and across the continent, where community health workers serve as the foundation of HIV care in rural and resource-limited settings.
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SOURCE: Motiki, R. (2025). A Critical Assessment of the Role of Village Health Workers in HIV/AIDS Retention Activities in Quthing District of Lesotho. MPhil thesis, HIV/AIDS Management, Stellenbosch University. Supervisor: Dr. Munyaradzi Saruchera.
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